Abstract

Background Inhaled corticosteroids (ICS) were first-line maintenance therapy for pediatric asthma. Objective This study aimed to examine the association between ICS dose intensity and the risk of asthma exacerbations in children. Methods A retrospective study was conducted among children with asthma who received budesonide treatment at Fuling District Maternal and Child Health Hospital of Chongqing between June 2023 and December 2025(n=138). Based on the average daily dose of budesonide(≤200μg/d, 201–400μg/d, and >400μg/d) maintained for 1–3 months, patients were categorized into low-dose(n=56), moderate-dose(n=52), and high-dose(n=30) groups. All patients were followed up for 12 months. Patients who developed asthma exacerbations during the follow-up period were classified into the exacerbation group(n=34), while the remaining patients were assigned to the non-exacerbation group(n=104). Results Among all patients, 55.1%(76/138) received budesonide monotherapy, 28.3%(39/138) received budesonide formoterol combination therapy, and 16.7%(23/138) received budesonide plus montelukast. The proportions of patients with a history of asthma exacerbations within the previous year were 21.4%(12/56), 32.7%(17/52), and 46.7%(14/30) in the low-dose, moderate-dose, and high-dose groups(P<0.05). During the 12-month follow-up, 24.6%(34/138) of patients experienced asthma exacerbations, with rates of 30.4%(17/56), 19.2%(10/52), and 23.3%(7/30) in the low-dose, moderate-dose, and high-dose groups(P>0.05). Compared with the non-exacerbation group, patients in the exacerbation group had a higher proportion of prior-year exacerbations [50.0%(17/34) vs 24.0%(25/104)] and higher eosinophil counts [(0.46±0.20)×109/L vs (0.36±0.16)×109/L] (P<0.05). Univariate logistic regression analysis showed that prior-year exacerbations [OR=2.36(95%CI,1.03–5.41),P=0.04] and elevated eosinophil counts [OR=1.31 (95%CI,1.01–1.69), P=0.04] were associated with an increased risk of asthma exacerbations. Conclusion Budesonide dose intensity was not significantly associated with the risk of asthma exacerbations in children, whereas prior exacerbation history and elevated eosinophil levels were identified as risk factors for exacerbations.